ABSTRACT Little is known about how genetic and environmental factors interact to affect child health outcomes. To address these knowledge gaps, the Environmental Influences on Child Health Outcomes (ECHO) program promises to leverage extant pediatric cohorts to test new hypotheses of how environmental exposures impact pediatric health. The Duke Clinical Research Institute (DCRI) proposes to serve as the ECHO Coordinating Center (ECHO CC) to provide the organizational framework for the management, direction, and overall coordination of all common ECHO activities. The DCRI is uniquely positioned to lead this ambitious initiative. As the world?s largest academic research organization, the DCRI manages nearly 30 active network and administrative coordinating center grants and has emerged as a leader in pediatric clinical research. The DCRI will leverage its broad contacts and networks in the larger pediatric research community, as well as established relationships with key university and industry collaborators, to support research in this underserved population. The economy of scale created by DCRI?s enterprise allows the use of common approaches to network functions and the ability to bring extra expertise to bear when inevitable problems and accelerated timelines arise. The overall goal of the ECHO CC is to efficiently manage collaborative research within the ECHO infrastructure to better understand the impact of environmental exposures on health outcomes in children. To achieve this vision, the ECHO CC will establish three components that will develop and implement innovative strategies across the design and conduct of research within ECHO: (1) the Steering Committee Support Component will coordinate and provide logistical support for all activities of the ECHO Steering and Executive Committees, External Scientific Board, NIH ECHO Team, ECHO cohorts, ECHO Cores, Data Analysis Center, and biorepositories; (2) the Scientific Focus Area Component will coordinate common research activities among the four ECHO scientific focus areas by developing ECHO-wide and focus area?specific protocols, procedures, and study documents to facilitate harmonization of outcomes specific to each scientific focus area; and (3) the Opportunities and Infrastructure Fund (OIF) Component will distribute funds to ECHO investigators to promote new projects, tools, and technologies and ensure successful completion of their projects. Overseeing all three of these components will be the ECHO CC Administrative Component. The ECHO CC goals will be met using established infrastructure within the DCRI and will be customized to meet the variable needs of the ECHO Cohorts, Steering Committee, and investigators. Using the highest research standards, our team will accomplish the goals set out by the NIH in managing this critically important collaborative effort.